title: Laparoscopic extralevator abdominoperineal excision of the rectum: short-term outcomes of a prospective case series.
abstract: BACKGROUND
  Laparoscopic approaches for the resection of low rectal cancer and the extralevator technique for abdominoperineal excision are both becoming increasingly popular. There are little published data regarding the combined application of these techniques to the resection of low rectal tumours. The aim of this study was to assess the feasibility of such an approach and to appraise short-term outcomes in a consecutive series of patients undergoing laparoscopic extralevator abdominoperineal excision (ELAPE).
  
  
  METHODS
  Consecutive patients undergoing laparoscopic ELAPE at our institution between 2008 and 2011 were identified from a prospectively maintained database. The abdominal phase of the operation was performed laparoscopically, and following extralevator resection, the perineum was reconstructed using a biologic mesh. All patients were enrolled in an enhanced recovery programme.
  
  
  RESULTS
  Of 166 patients undergoing radical resection of rectal cancer at our institution between 2008 and 2011, 28 underwent laparoscopic ELAPE. Median age was 70 years, median body mass index was 27.5 kg/m(2), and 71% were male. The conversion rate to laparotomy was 18%. Three patients (10.8%) had circumferential resection margins <1 mm; no intraoperative tumour perforation occurred. The median length of stay was 7 days, with a 30-day readmission rate of 21% and no 30-day mortality. Post-operative perineal wound complications occurred in 25%. At median 38-month follow-up (range 23-66 months), overall survival was 75%, disease-free survival was 71%, and there were three local recurrences (11%).
  
  
  CONCLUSIONS
  Laparoscopic extralevator abdominoperineal excision can be safely performed without compromising short-term outcomes.
authors.affiliation: Department of General Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, BA21 4AT, UK.
authors.forename: S L
authors.initials: SL
authors.lastname: Kipling
authors.forename: K
authors.initials: K
authors.lastname: Young
authors.forename: J D
authors.initials: JD
authors.lastname: Foster
authors.forename: N J
authors.initials: NJ
authors.lastname: Smart
authors.forename: A E
authors.initials: AE
authors.lastname: Hunter
authors.forename: E
authors.initials: E
authors.lastname: Cooper
authors.forename: N K
authors.initials: NK
authors.lastname: Francis
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D016896:Treatment Outcome; D006113:United Kingdom